中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
6期
518-521
,共4页
张林林%姜习凤%艾红珍%靳宗达%徐君翔%王兵%徐炜%谢宗刚%周海斌
張林林%薑習鳳%艾紅珍%靳宗達%徐君翔%王兵%徐煒%謝宗剛%週海斌
장림림%강습봉%애홍진%근종체%서군상%왕병%서위%사종강%주해빈
髋骨折%骨质疏松,绝经后%铁蛋白质类
髖骨摺%骨質疏鬆,絕經後%鐵蛋白質類
관골절%골질소송,절경후%철단백질류
Hip fractures%Osteoporosis,postmenopausal%Ferritins
目的 研究绝经后髋部脆性骨折患者血清铁过载指标与骨代谢指标间的相互关系,对两者的临床表现进行探讨.方法 回顾性研究2011年2月至2012年6月76例绝经后髋部脆性骨折患者资料,年龄55 ～ 93岁,平均(73±10)岁；绝经时间5～50年,平均(22±10)年.患者均检测血清铁蛋白、转铁蛋白、碱性磷酸酶(ALP)、Ⅰ型原胶原氨基端延长肽(P1NP)、Ⅰ型胶原C端肽B降解产物(β-CTX)和双能X线股骨颈腰椎骨密度指标.采用t检验、Pearson线性相关分析、多元逐步回归分析、偏相关分析,观察铁代谢指标与骨代谢相关指标的关系.结果 患者血清铁蛋白值升至(230±146) μg/L,转铁蛋白降至(1.89±0.33)g/L.血清P1 NP升至(61±32) ng/L,ALP、β-CTX均在正常范围内.股骨颈和腰椎骨密度T值分别为-2.0±1.1和-2.1±1.2(正常范围-1.0～1.0).将患者按照其血清铁蛋白情况分为铁蛋白正常组(血清铁蛋白≤150 μg/L,25例)和铁蛋白升高组(血清铁蛋白＞ 150μg/L,51例).铁蛋白升高组较铁蛋白正常组的股骨颈和腰椎骨密度降低(t=3.13、2.89,P＜0.01),P1 NP和β-CTX升高(t=-2.38、-3.59,P＜0.05).校正混杂因素后,铁蛋白值与股骨颈和腰椎骨密度T值呈负相关(r=-0.335、-0.295,P＜0.05),与P1NP和β-CTX值呈正相关(r=0.467、0.414,P＜0.05),与ALP无显著相关性(r=0.188,P＞0.05)；转铁蛋白值与股骨颈和腰椎骨密度T值呈正相关(r =0.444、0.262,P＜0.05),与ALP、P1NP、β-CTX值呈负相关(r=-0.326、-0.285、-0.278,P＜0.05).结论 绝经后髋部脆性骨折患者存在铁过载现象,铁过载与骨转换活跃导致骨量丢失相关,体内铁过载可能是一个独立影响绝经后骨代谢异常的因素.
目的 研究絕經後髖部脆性骨摺患者血清鐵過載指標與骨代謝指標間的相互關繫,對兩者的臨床錶現進行探討.方法 迴顧性研究2011年2月至2012年6月76例絕經後髖部脆性骨摺患者資料,年齡55 ～ 93歲,平均(73±10)歲；絕經時間5～50年,平均(22±10)年.患者均檢測血清鐵蛋白、轉鐵蛋白、堿性燐痠酶(ALP)、Ⅰ型原膠原氨基耑延長肽(P1NP)、Ⅰ型膠原C耑肽B降解產物(β-CTX)和雙能X線股骨頸腰椎骨密度指標.採用t檢驗、Pearson線性相關分析、多元逐步迴歸分析、偏相關分析,觀察鐵代謝指標與骨代謝相關指標的關繫.結果 患者血清鐵蛋白值升至(230±146) μg/L,轉鐵蛋白降至(1.89±0.33)g/L.血清P1 NP升至(61±32) ng/L,ALP、β-CTX均在正常範圍內.股骨頸和腰椎骨密度T值分彆為-2.0±1.1和-2.1±1.2(正常範圍-1.0～1.0).將患者按照其血清鐵蛋白情況分為鐵蛋白正常組(血清鐵蛋白≤150 μg/L,25例)和鐵蛋白升高組(血清鐵蛋白＞ 150μg/L,51例).鐵蛋白升高組較鐵蛋白正常組的股骨頸和腰椎骨密度降低(t=3.13、2.89,P＜0.01),P1 NP和β-CTX升高(t=-2.38、-3.59,P＜0.05).校正混雜因素後,鐵蛋白值與股骨頸和腰椎骨密度T值呈負相關(r=-0.335、-0.295,P＜0.05),與P1NP和β-CTX值呈正相關(r=0.467、0.414,P＜0.05),與ALP無顯著相關性(r=0.188,P＞0.05)；轉鐵蛋白值與股骨頸和腰椎骨密度T值呈正相關(r =0.444、0.262,P＜0.05),與ALP、P1NP、β-CTX值呈負相關(r=-0.326、-0.285、-0.278,P＜0.05).結論 絕經後髖部脆性骨摺患者存在鐵過載現象,鐵過載與骨轉換活躍導緻骨量丟失相關,體內鐵過載可能是一箇獨立影響絕經後骨代謝異常的因素.
목적 연구절경후관부취성골절환자혈청철과재지표여골대사지표간적상호관계,대량자적림상표현진행탐토.방법 회고성연구2011년2월지2012년6월76례절경후관부취성골절환자자료,년령55 ～ 93세,평균(73±10)세；절경시간5～50년,평균(22±10)년.환자균검측혈청철단백、전철단백、감성린산매(ALP)、Ⅰ형원효원안기단연장태(P1NP)、Ⅰ형효원C단태B강해산물(β-CTX)화쌍능X선고골경요추골밀도지표.채용t검험、Pearson선성상관분석、다원축보회귀분석、편상관분석,관찰철대사지표여골대사상관지표적관계.결과 환자혈청철단백치승지(230±146) μg/L,전철단백강지(1.89±0.33)g/L.혈청P1 NP승지(61±32) ng/L,ALP、β-CTX균재정상범위내.고골경화요추골밀도T치분별위-2.0±1.1화-2.1±1.2(정상범위-1.0～1.0).장환자안조기혈청철단백정황분위철단백정상조(혈청철단백≤150 μg/L,25례)화철단백승고조(혈청철단백＞ 150μg/L,51례).철단백승고조교철단백정상조적고골경화요추골밀도강저(t=3.13、2.89,P＜0.01),P1 NP화β-CTX승고(t=-2.38、-3.59,P＜0.05).교정혼잡인소후,철단백치여고골경화요추골밀도T치정부상관(r=-0.335、-0.295,P＜0.05),여P1NP화β-CTX치정정상관(r=0.467、0.414,P＜0.05),여ALP무현저상관성(r=0.188,P＞0.05)；전철단백치여고골경화요추골밀도T치정정상관(r =0.444、0.262,P＜0.05),여ALP、P1NP、β-CTX치정부상관(r=-0.326、-0.285、-0.278,P＜0.05).결론 절경후관부취성골절환자존재철과재현상,철과재여골전환활약도치골량주실상관,체내철과재가능시일개독립영향절경후골대사이상적인소.
Objective To study relationships between serum ferritin and bone metabolism in patients with hip fragility fractures.Methods This cross-sectional study included 76 postmenopausal women with hip fracture from Feburary 2011 to June 2012.The mean age of the women was (73 ± 10) years (range,55-93 years) and the mean duration of menstruation was (22 ± 10)years (range,5-50 years).Serum concentrations of ferritin,transferrin,alkaline phosphatase (ALP),amino-terminal extension peptide of type Ⅰ collagen (P1NP),C-terminal telopeptides of type Ⅰ collagen (β-CTX)and femoral and lumbar bone mineral density by dual-energy X-ray absorptiometry were measured.Bone metabolism was compared between normal and elevated ferritin groups with t-test,Pearson linear,partial correlation and multiple regression analysis examined associations between iron-and bone-related markers.Results Serum ferritin concentration raised to (230 ± 146) μg/L,transferrin concentration reduced to (1.89 ±0.33)g/L,P1NP concentration raised to (61 ± 32) ng/L when the concentration of serum ALP and β-CTX were in the normal range.T-scores for bone mineral density in the femoral neck (-2.0 ± 1.1) and lumbar (-2.1 ± 1.2)were below the normal ranges (-1.0-1.0).The subjects were divided into two groups according to serum ferritin concentration,normal group(serum ferritin concentration≤ 150 μg/L,n =25) and elevated group (serum ferritin concentration ＞ 150 μg/L,n =51).Patients of elevated group had lower bone mineral density in femoral neck and lumbar than normal group (t =3.13,2.89,P ＜ 0.01),and higher P1NP,β-CTX concentration(t =-2.38,-3.59,P ＜ 0.05).In partial correlation analysis adjusted for confounders,serum ferritin concentration was correlated negatively with bone mineral density in both femoral neck and lumbar (r =-0.335,-0.295,P ＜ 0.05),and positively with P1NP and β-CTX (r=0.467,0.414,P ＜ 0.05),but not correlated with ALP (r =0.188,P ＞ 0.05).Transferrin concentration tended to be correlated positively with bone mineral density in both femoral neck and lumbar (r =0.444,0.262,P ＜0.05) and negatively with ALP,P1NP and β-CTX(r =-0.326,-0.285,-0.278,P ＜0.05).Conclusions Iron overload has a high prevalence in postmenopausal women with fragility fracture.Increased iron stores,which might lead to bone loss and lower bone mineral density by enhancing the activity of bone turnover,could be an independent factor to take effects on bone metabolism on postmenopausal women.
